PEDIATRIC PREVENTIVE CARE INCENTIVES IN A MEDICAID HMO

这项随机对照试验将评估系统的影响， 定期反馈和财政激励措施， HealthPASS中的预防护理临床指南，这是一项强制性医疗补助计划 费城的健康维护组织 该研究将调查该规定是否 每六个月向研究中心提交一份详细的反馈报告， 专门与预防保健挂钩的财政奖金计划， 根据HMO目前观察到的儿科标准遵守率， 百分之六十 具体的研究问题是：1） 干预改变了对预防保健指南坚持，如果是这样， 在何种程度上; 2）不同的预防保健组成部分是否受到影响 不同; 3）干预措施对医生的影响有多快 行为;以及，4）效果的大小如何不同， 不同类型的供应商？ 约51名儿童 参与HealthPASS和会议研究的初级保健站点 合格标准将随机分配给实验或 对照组 两组中的研究中心将每六个月进行一次审计 使用HealthPASS的审计工具和程序，您可以在两年内连续使用两个月。 将确定是否符合儿科预防保健指南 使用计算机化评分算法。 实验地点将收到 每六个月就他们的表现提交详细的反馈报告， 表现良好和/或大幅改善的网站将获得 财务奖金。 这项研究之所以重要，有几个原因： 注重使用财务激励措施来提高质量，而不是 限制使用;它使用前瞻性，随机设计，提高 关于激励的先前研究;它旨在提高对 为传统上得不到充分服务的少数民族人口提供预防保健;以及， 它是在一个被认为是世界上最重要的 为穷人和无保险者提供护理的模式。

This randomized controlled trial will assess the impact of a system of periodic feedback and financial incentives on compliance with pediatric preventive care clinical guidelines in HealthPASS, a mandatory Medicaid HMO in Philadelphia. The study will investigate whether the provision of detailed feedback reports to sites every six months, linked with a financial bonus program specifically tied to preventive care, improves on the HMO's currently observed pediatrics standards compliance rate of 60 percent. The specific research questions are: 1) does the intervention change adherence to preventive care guidelines, and, if so, to what extent; 2) are different preventive care components affected differently; 3) how quickly does the intervention influence physician behavior; and, 4) how does the magnitude of the effect differ for different types of provider practices? Approximately 51 pediatric primary care sites participating in HealthPASS and meeting study eligibility criteria will be randomly assigned to an experimental or control group. Sites in both groups will be audited once every six months for two years, using HealthPASS' auditing tools and procedures. Compliance with pediatric preventive care guidelines will be determined using computerized scoring algorithms. Experimental sites will receive detailed feedback reports on their performance every six months, and sites which perform well and/or improve substantially will receive financial bonuses. The study is significant for several reasons: it focusses on using financial incentives to improve quality, rather than to limit utilization; it uses a prospective, randomized design, improving on previous research on incentives; it seeks to improve attention to preventive care for a traditionally underserved minority population; and, it is being undertaken in a setting which is considered one of the major models for providing care to the indigent and uninsured.